This K24 renewal application will continue to derive evidence in the field of hand surgery by focusing on the treatment of distal radius fractures (DRF) to teach trainees evidence-based practice and principles. The principal investigator (PI) is a health services researcher whose interests include evidence-based medicine, epidemiology and outcomes research. The PI's previous research has concentrated on musculoskeletal diseases such as rheumatoid arthritis and distal radius fractures (DRF), particularly among the elderly. In addition to continuing research on DRF outcomes, this grant will incorporate a mentoring program to teach evidence-based medicine and research methodology to a growing number of junior faculty, surgery residents, international fellows and medical students. The goal of this project is to initiate a randomized-controlled clinical trial to compare outcomes of two hand therapy programs for elderly patients with DRF, which is the most common injury affecting this growing population. Patients treated with open reduction and internal fixation of DRFs using the volar locking plating system (VLPS) will receive fully-supervised hand therapy (FHT) or minimally supervised self-directed hand therapy (MHT). The specific aims of the study are (1) To conduct a randomized controlled trial comparing MHT versus traditional FHT for DRFs in the elderly treated with VLPS, and 2) To develop a predictor model to identify patients who will benefit from FHT. The data derived from this study will provide vital information about the postoperative management of this injury and define predictors of functional outcomes after open reduction and internal fixation of DRFs. Furthermore, this study will yield evidence to assist healthcare providers in giving the best care to DRF patients and generate economic data to potentially reduce costs nationally. The principal focus of this K24 award is to apply this project to educate trainees about evidence-based medicine, epidemiology, statistics and study methodology. entire application (candidate, environment, and research). Include the candidate's immediate and long-term career goals, key elements of the research career development plan, and a description of the research project, as indicated in Part I.4.4.6. Provide an abstract of th entire application (candidate, environment, and research). Include the candidate's immediate and long-term career goals, key elements of the research career development plan, and a description of the research project, as indicated in Part I.4.4.6. CC